Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compli...
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Robert P. Sticca, MD, FACS Jay M. MacGregor, MD Randolph E. Szlabick, MD, FACS - PowerPoint PPT Presentation


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Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compliance with Work Hours Regulations?. Robert P. Sticca, MD, FACS Jay M. MacGregor, MD Randolph E. Szlabick, MD, FACS Department of Surgery University of North Dakota SMHS. Background.

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Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compliance with Work Hours Regulations?

Robert P. Sticca, MD, FACS

Jay M. MacGregor, MD

Randolph E. Szlabick, MD, FACS

Department of Surgery

University of North Dakota SMHS


Background
Background General Surgery Residency Programs Compliance with Work Hours Regulations?

  • 2003 – ACGME work hours regulations implemented

  • 2004 – ACGME Residents/Fellows Survey

  • 2008 – Special Message from CEO ACGME (Thomas Nasca, MD)

    • Standard Approach to Programs Across All Specialties with Potential Duty Hours Violations Identified in the Resident Survey


Acgme special message
ACGME Special Message General Surgery Residency Programs Compliance with Work Hours Regulations?

  • The Monitoring Committee has accepted the Resident Survey as a reliable, sensitive and reasonably specific tool

  • The Monitoring Committee has set reasonable thresholds for categorization of a program as having Potential Duty Hours Violations (PDHV) based on the Resident Survey

  • The validity of the Resident Survey has been demonstrated though significant correlations with site visit findings to warrant added scrutiny for programs meeting the thresholds of potential noncompliance found in the group targeted for follow-up.

  • There is a significant correlation between resident reported violations of duty hours with deficiencies in other important areas of the learning environment(correlation 0.51, p<0.0001)

Nasca, T. www.ACGME.org


Acgme algorithm for noncompliant programs
ACGME Algorithm for Noncompliant Programs General Surgery Residency Programs Compliance with Work Hours Regulations?

Nasca, T. www.ACGME.org


Und experience
UND Experience General Surgery Residency Programs Compliance with Work Hours Regulations?

  • 2005 – RRC site visit – additional categorical resident requested

    • 5 year approval, no deficiencies

    • Additional resident denied, insufficient educational justification

  • 2007 – RRC site visit – additional categorical resident requested

    • 5 year approval, no deficiencies

    • Additional resident approved

  • 2009 – RRC site visit – mandatory due to residents responses on survey

    • 5 year approval - commendation


Acgme survey problems
ACGME Survey - Problems General Surgery Residency Programs Compliance with Work Hours Regulations?

  • Answer selections vague

  • High threshold for compliance

  • Small program effect

  • Consequences of survey punitive

  • Consequences based on survey results and not actual work hours data


Current study
Current Study General Surgery Residency Programs Compliance with Work Hours Regulations?

  • Purpose – obtain general surgery residents views on work hours regulations and ACGME survey

  • Design – 20 question survey emailed to all Gen. Surg. Program Directors – 5/09

    • 9 questions – work hours

    • 9 questions – ACGME survey

    • 1 both, 1 demographic, comments

  • Study period – 5/09 – 10/09

    • Multiple reminders, pleas for participation

  • Internet Survey – surveymonkey.com


Questions
Questions General Surgery Residency Programs Compliance with Work Hours Regulations?


Results
Results General Surgery Residency Programs Compliance with Work Hours Regulations?

  • Answers collected, analyzed - 11/09

  • Aggregate

  • Level of training

    • Junior – PGY 1, 2

    • Senior – PGY > 2

  • Statistical analysis – openepi.com

    • P value < 0.05, statistically significant


Results responses
Results - Responses General Surgery Residency Programs Compliance with Work Hours Regulations?

965 – 13.1 % of U.S. General Surgery Residents

961 completed entire survey (99.6%)

Junior Residents – 441 Senior Residents – 520


Results number times survey taken
Results General Surgery Residency Programs Compliance with Work Hours Regulations?Number Times Survey Taken


Results instruction on survey
Results General Surgery Residency Programs Compliance with Work Hours Regulations?Instruction on Survey


Results survey interpretation
Results – Survey Interpretation General Surgery Residency Programs Compliance with Work Hours Regulations?


Results effect on program
Results General Surgery Residency Programs Compliance with Work Hours Regulations?Effect on Program


Results honesty accuracy
Results General Surgery Residency Programs Compliance with Work Hours Regulations?Honesty/Accuracy


Conclusions
Conclusions General Surgery Residency Programs Compliance with Work Hours Regulations?

  • Evaluation mechanism in which

    • 52% do not understand questions

    • 14% did not answer truthfully

    • 37% do not feel is accurate

  • Not best tool to evaluate work hours compliance in residency programs

  • Consequences significant

  • Open letter to GME community 10/28/09

    • www.acgme.org

Nasca, T. www.ACGME.org


Thank you
Thank you !! General Surgery Residency Programs Compliance with Work Hours Regulations?

Program Directors

Residents


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